For Some Older Adults, Anticholinergics May Provide Cognitive Benefits

The possible therapeutic effects in controlling comorbidities may outweigh the adverse effects on cognition

Older adults with questionable cognitive impairment exposed to anticholinergics demonstrated higher global cognitive scores compared to those not exposed to anticholinergics, according to a study published in Drugs & Aging.

Older adults are generally more susceptible to the adverse effects of anticholinergic medications due to age-associated decline in central cholinergic activity. In order to examine the associations of anticholinergics on cognition among older adults with questionable cognitive impairment, researchers conducted a cross-sectional study. A total of 7,351 adults aged 60 years and older with questionable cognitive impairment were included.

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The Anticholinergic Drug Scale was used to categorize anticholinergic drug load into "no," "low" or "moderate/high" groups. Questionable cognitive impairment was defined as study patients with a Clinical Dementia Rating-Sum of Boxes score between 0.5–2.5. Cognitive performance was evaluated using the Neuropsychological Test Battery.

The data showed global cognition was significantly greater in the moderate/high anticholinergic exposure group vs. the no anticholinergic group (–0.23 vs. –0.32). Also, global cognition score among the low- and moderate/high anticholinergic groups was 0.064 higher than the no anticholinergic group (P=0.0006 and P=0.012, respectively).

Study findings suggest older adults may receive some cognitive benefit from anticholinergic agents. This may be due to possible therapeutic effects in controlling comorbidities thus outweighing their adverse effects on cognition.